Update at 1:13 p.m. Federal regulators just confirmed that Renaissance Hospital Terrell has been shut down in the wake of recent patient-care breakdowns that included two deaths.

“There are no staff or patients in the facility, and it is not providing any care at all,” according to a statement CMS sent me moments ago.

Agency officials are now trying to notify Kaufman County residents that they have several care options within 25 miles of Terrell that I’ve listed at the bottom of this post in bold.

Original item at 12:17 p.m. In a rare action, federal and state health regulators are moving to shut down Renaissance Hospital Terrell for recklessly endangering patients, including nursing failures they say led to two deaths.

As of midnight, the lone hospital serving Terrell, southeast of Dallas in Kaufman County, became only the ninth hospital in the U.S. during the last three years to see its funding cut off by the U.S. Centers for Medicare & Medicaid Services, records show. And it’s only the fifth time since 2007 the Texas Department of State Health Services has moved to revoke a hospital’s license, that agency says.

We’re still trying to piece together the facts. But a January inspection report I obtained from CMS shows the 102-bed hospital – owned by RH Terrell Management LLC, as listed in state records – has violated 15 safety regulations in recent months, placing patients in the most serious threat category, “immediate jeopardy.’’

Early this afternoon, Parkland Memorial Hospital officials announced that they will place their troubled psychiatric services under the management of privately owned Green Oaks Hospital in Dallas.

News of the $1.1 million annual deal, posted on the hospital’s web site, is the culmination of confidential talks since November between the two parties. It marks a potentially significant shift for Parkland amid ongoing warnings from federal safety monitors that it needs to find a solution to persistent threats to psych patients.

The media statement said Parkland’s board of managers approved the deal — with member Dr. Winfred Parnell abstaining — during a Wednesday night meeting. Prior to the meeting, the hospital didn’t follow its usual practice of posting an advance meeting agenda and information packet on its website alerting the public.

Green Oaks, owned by Nashville, Tenn.-based HCA, provides a range of mental-health care from inpatient to ER services at its site near the Medical City Dallas Hospital campus. It also runs outpatient clinics or other facilities in Dallas, McKinney, Plano and Irving.

At Parkland, Green Oaks will provide an administrative director, nursing director, performance improvement director and a community liaison for psychiatric services, the statement said. Joe Householder, a spokesman for Parkland, told me that the deal “in no way alters the relationship/contract with” UT Southwestern Medical Center. UTSW, Parkland’s academic affiliate, is paid to supply faculty physicians to provide clinical care.

At a time Parkland Memorial Hospital needs a critical blessing from federal regulators to avoid a shutdown, its officials have struck a $500,000 deal with a powerhouse lobbying firm to protect its regulatory interests in Washington D.C.

The hiring of Holland & Knight, one of the biggest lobbying firms in the country, comes during arguably the most pivotal, pressure-packed phase of the taxpayer-supported hospital’s history. Over the next 12 weeks, it must prove to the U.S. Centers for Medicare & Medicaid Services that it’s a danger-free hospital as part of a rare safety oversight agreement. If the hospital fails, regulators have said they will cut off about $400 million in healthcare dollars vital to its survival. And lately, serious flaws have been found in reform measures Parkland has put into place.

A big question: Will Holland & Knight be lobbying the U.S. Centers for Medicare & Medicaid Services or other government officials to try to somehow modify the monitoring process or seek leniency?

Parkland Board member Eddie Reeves told me today there was no intention to “undercut” the oversight process using Holland & Knight. Reeves called me this afternoon to emphasize that point after reading my earlier post noting that Parkland administrative officials who put together the lobbying deal refused to answer my questions.

As readers of this blog know, they have consistently refused to divulge detailed information about the monitoring process or answer most questions that may pertain to it, usually citing fears of litigation.

On this blog post, I’m providing the public links to documents underlying events on each front: The December compliance report I detailed in Monday’s paper, describing pitfalls in the implementation of care reforms. And the lobbying contract Parkland signed with Holland & Knight this week.

To get a handle on Holland & Knight’s lobbying muscle, check out its profile on the Center for Responsive Politics website here, which tracks billings and areas of political influence.

Just a few days ago, Dr. Ron Anderson quietly departed the leadership ranks of troubled Parkland Memorial Hospital after three decades.

Anderson was ousted as CEO in late 2011 following a long series of patient-care breakdowns that triggered a virtual takeover of Parkland by the federal government. As safety monitors led a massive reorganization to eliminate dangers to patients over the last year, Anderson worked off campus as a paid consultant on fundraising issues.

When the December expiration of his contract came up during a Parkland Board of Managers meeting last month, hospital leaders had very little to say. “He will no longer represent Parkland in any capacity,” interim CEO Bob Smith told the board.

The relative silence surrounding Anderson’s exit may end this morning, when the Dallas County Commissioners Court considers a resolution of tribute to the former Parkland CEO. A draft of the document commends Anderson’s “trailblazing efforts” to advocate for the uninsured and improve health care.

Commissioner Mike Cantrell told me that he sponsored the resolution because he feels Parkland’s problems in recent years under Anderson shouldn’t detract from his record of success.

“I think everyone on that court would recognize that Dr. Anderson has been a leader for the past 30 years,” Cantrell said. “So I would be extremely surprised and disappointed” if they declined to support the resolution.

Parkland did not pay a $750,000 fine when it was due in September. As a result, state officials say, the public hospital may owe more money.

“There is simply no excuse for what happened,” said a statement issued on behalf of Debbie Branson, chair of Parkland’s governing board. “Appropriate changes will result.”

Branson and other Parkland representatives did not respond to a request for elaboration. But records obtained by The Dallas Morning News do recount an explanation that two hospital leaders gave in a Dec. 4 phone call to a Texas Department of State Health Services employee.

“They had it set up in their accounting section to send a wire transfer,” says the summary, but “the person that was responsible for sending it out resigned before it was sent.”

Parkland would not identify the employee or the reason for resignation. Continue reading →

A new federal report adds perspective to the sweeping criminal indictment earlier this year of a Dallas-area physician who allegedly bilked the government of $375 million through bogus health-care claims.

You’ll recall that the U.S. Department of Justice called the case involving Dr. Jacques Roy of Rockwall the largest home-healthcare fraud ever coordinated by a single physician.

The GAO found that only 14 percent of 7,848 subjects – both individuals and medical entities – investigated for criminal health-care fraud by federal agencies were prosecuted in 2010, the latest data available.

Why weren’t charges pursued in the vast majority of cases? A lack of resources. Insufficient evidence. Sometimes the case was outside the jurisdiction of an agency such as the DOJ or the U.S. Department of Health and Human Services, GAO said.

The report didn’t delve deeply into those reasons. The main thrust of the report, requested by members of Congress, was to provide a profile of providers involved in both criminal and civil fraud cases.

Among the criminal cases in 2010, non-hospital facilities such as medical centers, clinics, private practices, and durable medical equipment suppliers, were the “most-frequent subjects investigated.” Among civil fraud cases, hospitals were the most common targets of investigations.

Of the 14 percent of cases criminally charged, the vast majority resulted in a finding of guilt or no contest.

Roy has pleaded not guilty to multiple counts of conspiracy, obstructing justice and fraud. He is expected to stand trial next year. One of his co-defendants, Cyprian Akamnonu, pleaded guilty Thursday to one count of conspiracy to commit health-care fraud.

A new federal report grabbing national headlines today raises the specter that some of the government’s hired guns for smoking out Medicare fraud and waste could be seriously compromised.

The study by the U.S. Department of Health and Human Services’ inspector general reviewed bids from about 100 potential contractors seeking contracts to investigate financial abuses in the government insurance program serving the elderly and disabled. Those companies, the IG found, “often had business and contractual relationships” with firms they could be investigating. In fact, nearly 2,000 business relationships were cited as possible conflicts, and 16 termed “actual” conflicts.

Failure to prevent such conflicts among “program integrity contractors” can obviously undermine efforts to expose and fight fraud, the report warns.

“For example, a program integrity contractor owned by a health insurance
company offering a Medicare prescription drug plan might have a
disincentive to investigate suspected fraud involving those particular
prescription drug plans,” the IG said.

Parkland Memorial Hospital’s refusal to release monthly regulatory report cards has led to a slow drip of information about its progress in eliminating dangers to patients.

Last month, we scooped up enough details from comments during a hospital board meeting to report that Parkland, as of April, was behind schedule on two critical government safety mandates: making sure enough psychiatrists are on duty, and developing a system to track the safe supervision of doctors-in-training.

We’re collecting the monthly compliance reports, produced by federally installed safety monitors, as fast as we can. But it can take weeks because we have to reach all the way to the Baltimore headquarters of the U.S. Centers for Medicare & Medicaid Services to get them. Unlike Parkland, CMS views them as public records. But because the agency tackles hundreds of open-record requests across the U.S., we obviously have to wait in line.

Now we’ve received the April report card, and of course it contains details Parkland officials have kept quiet. We’re uploading the document at the end of this post so you can read it yourselves.